Financial Assistance Policy Plain Language Summary

Mount Auburn Hospital (MAH), a non-profit acute care hospital, was established to serve the needs of the residents of and surrounding areas. The hospital is committed to providing medical services to patients regardless of their ability to pay. MAH recognizes that not all patients have the financial resources to pay their hospital bill. This Plain Language Summary provides basic information about our financial assistance policy. The Financial Assistance Policy, Application MAH Financial Assistance Policy and Plain Language Summary Are Available in Our financial counseling staff will assist individuals Multiple Languages in applying for eligible government health insurance Financial Assistance Policies, Applications and Plain programs and completing the financial assistance Language Summaries are available in the following application, free of charge. The Financial Assistance languages: Program offers emergency and other eligible medically necessary services at no cost to qualified English Spanish French patients. Whether patients are uninsured or Haitian Creole Simplified Chinese Traditional Chines underinsured, they can apply for financial assistance. Portuguese Greek Russian Upon approval, patients may receive the following Armenian assistance with respect to any patient responsible balance for eligible medical services: Coverage under the Financial Assistance Policy Patients must have applied for government health Charity Care insurance programs within 6 months of applying for Federal Poverty Level Amount of Assistance financial assistance to be eligible for assistance from At or below 400% 100% MAH. Patients/guarantors may apply for financial assistance at any time up to two hundred forty (240) days Medical Hardship after the first post-discharge billing statement is A 100% discount for patients whose medical bills available. are greater than or equal to 25% of their gross family income. Return your completed application to: Mount Auburn Hospital Financial Assistance Dep’t IMPORTANT: Out-of-network copays, 330 Mount Auburn Street, Clark Building, 2nd Floor coinsurance and deductibles are not eligible for Cambridge, MA 02138 financial assistance. In no case will a patient eligible for financial assistance be charged more than the If approved, financial assistance will apply to: amounts generally billed to patients with • Anna Jaques Hospital insurance. • Addison Gilbert Hospital

How to Obtain Copies of our Financial • BayRidge Hospital Assistance Program Policy and Application • Beth Israel Deaconess Medical Center You may obtain a copy of our policy and application • Beth Israel Deaconess Hospital-Milton form free of charge in the following ways: • Beth Israel Deaconess Hospital-Needham • MAH website: • Beth Israel Deaconess Hospital-Plymouth https://www.mountauburnhospital.org/patients- • Beverly Hospital visitors/billing-insurance/billing-policies/ • Lahey Hospital & Medical Center • Visit our Financial Counseling Office located at: • Lahey Medical Center, Peabody Mount Auburn Hospital Financial Assistance • Mount Auburn Hospital Department • New England Baptist Hospital 330 Mount Auburn Street, Clark Building, 2nd Floor • Cambridge, MA 02138 • Request copies to be mailed or sent Note: Certain physicians are not covered under the electronically by calling (617) 499-5560 (you BIDMC Financial Assistance Policy. Please visit our may also call this number to request assistance website or contact us at (617) 499-5560 for more with the application process) information. • Admission/Registration Areas at MAH • Certified Application Counselor Offices • In our emergency department Revised 10/2020